Neurocritical Care: A Growing International Collaborative

  
NCJ_cover.jpgBy Andreas H. Krame, Philippe Couillard

First Online: 30 September 2019

Patients with neurological conditions account for at least 10–15% of admissions to intensive care units (ICUs) [1]. In addition, many critically ill patients with sepsis or respiratory failure develop neurological complications, such as delirium, non-convulsive status epilepticus, or neuromuscular weakness, which may in turn contribute to morbidity and an increased risk of mortality [2, 3, 4]. Neurocritical care is a maturing subspecialty of critical care medicine that seeks to integrate content expertise in critical care neurology, skill and experience in general critical care management, and consistent provision of evidence-based practices for patients with brain or spinal cord injuries. The aim is to provide meticulous neuroprotection, avoidance of secondary neurological injury, prompt recognition and treatment systemic complications, and, ultimately, the best possible recovery.

A large number of observational studies have suggested that the addition of specific expertise in neurocritical care within a healthcare system is strongly associated with reductions in mortality and improved outcomes (Fig. 1) [5, 6]. The strongest evidence supporting neurocritical care models has been for patients with spontaneous intracerebral and subarachnoid hemorrhage. More recent publications (with some exceptions), including several from outside North America or Europe, have largely reported similar results [7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18]. There is also growing evidence that higher patient volume within a center is associated with improved outcomes [19, 20].

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